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PDAT3 > 12 - Enteral Nutrition > Flashcards

12 - Enteral Nutrition Flashcards

1
Q

Why do we choose ENTERAL NUTRITION > Parenteral

A

IMMUNE FUNCTION
BILE + IGA
Mucus Layer / Tight Junction(enterocytes) /MALT = Leukocytes

  • *Intestinal Tract Integrity**
  • minimize bacterial & endotoxin Translocation*
  • *Additional Nutrients are available**
  • *Glutamine / MCT / Dietary Fiber**

LESS COSTLY

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2
Q

Contraindications for EN

A

SEVERE GI Disturances

Intestinal Obstruction

Necrotizing Enterocolitis

Adynamic Ileus

Intractable Vomiting

Upper GI Bleed

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3
Q

Methods of Administration - EN

  • *Long Term Access**
  • *>4-6 weeks**
A

Percutaneously Placed Jujustomy = PEJ
most common

Percutaneously Placed Gastotomy = PEG
directly into stomach

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4
Q

Methods of Administration - EN

  • *NASOENTERIC TUBES = Short-Term Therapy**
  • *<4-6 weeks**

-duodenal

-jejunal

-gastric

A

NG / OG -gastric
used in patients with INTACT GAG REFLEXES
most common

ND / OD - duodenal
patients with gastroparesis or poor gag-reflexes

NJ / OJ - jujenal
same as -duodenal but also for patients with
PANCREATITIS

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5
Q

Taste Considerations

Protein & Carbs

A
  • *WHOLE PROTEIN** = Taste better
  • *more Complex**
  • *Simpler Sugars = Fructose / Sucrose / HFCS**
  • SWEETER** but *less complex & MORE Osm activity
  • opposite from protein*
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6
Q

Protein Sources

Glutamine // L-Arginine

Both good for CRITICALLY ILL PATIENTS

A

Glutamine
important in maintaining integerity of intestinal mucosa = ENTEROCYTE HELP
Intestinal epithelia consumes glutamine –> IgA

L-Arginine
may improve collagen synthesis & wound healing
ENHANCE T-CELL FUNCTION

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7
Q

Fat Sources

LCT // MCT

Typically a MIX of Both

A

Long Chain Triglycerides = LCT
Require LIPASE to break down into FFA
more complex
CONTAINS ESSENTIAL FATTY ACIDS

  • *Medium Chain Triglycerides = MCT**
  • *-Acid**, does not need lipase
  • *passively absorbed**
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8
Q

Fat Source

OMEGA 3 FA

A

for CRITICALLY ILL

Alter CYTOKINE production

  • decrease:*
  • *TNF & IL-1 Synthesis**
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9
Q

Formula Selection

POLYMERIC FORMULAS

A

Require:
Normal Digestive & Absorptive Capability

Provide:
100% of RDA for Vit/min/trace elements

Osmolite / Jevity

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10
Q

Formula Selection
MONOMERIC / HYDROLYZED formulas

For ICU patients
since they can’t digest very well

HIGH Osmolarity
since they are BROKEN DOWN

Minimal residue –> more diarrhea

POOR TASTE

A

Peptide Based
Oligopeptides + di/tripeptides
FAT = 25-30%of calories
NOT COMPLETELY BROKEN DOWN
needs SOME GI FUNCTION

  • *Elemental Based**
  • *AA / low fat content = 10% FAA**
  • *COMPLETELY DIGESTED**
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11
Q

Disease-Specific Formula

CRITICALLY ILL = IMPACT

A

Arginine Glutamine + OMEGA 3 FA

HIGH PROTEIN = 24%

HIGH BCAA
directly used by skeletal muscle

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12
Q

Disease-Specific Formula

DIABETIC = GLUCERNA

A

LESS CARBOHYDRATES = 34%

Monosaturated Fats

SOLUBLE & INSOLUBLE FIBER

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13
Q

Disease-Specific Formula

RENAL = NEPRO / RENALCAL

A

LOW ELECTROLYTES

Concentrated - 1.8 kcal/mL

HIGH Essential AA
more essential –> make non-essential on their own
LESS AZOTEMIA

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14
Q

Disease-Specific Formula

HEPATIC = NUTRIHEP

A

HIGH BCAA = 45%

to AVOID hepatic Enephalopathy!

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15
Q

Modular Formulas

A

Single or Multiple nutrients to ENHANCE a standard formula

ALTER THE RATIOS
of principle nutrients, without affecting OTHER nutrients

BENEFIBER

BENEPROTEIN

MCT OIL

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16
Q

BOLUS FEEDINGS
Techniques of Administration

A
  • *HOME SETTING**
  • not common in hosptitals*

Gastric Feedings Only
mimics NORMAL feeding

Over 1-4 Hours, MAX 60mL/ min

Start 50-100mL –> increase in 100mL increments

  • *Typical amount of formula per feeding is:**
  • *240 -400mL**
  • depends on caloric density & protein content of formula along with pt’s energy & protein needs*
17
Q

CONTINUOUS FEEDINGS
​Techniques of Administration

A

HOSPITAL SETTING
Esp: CRITICALLY ILL & DIABETIC PATIENTS

Gastric / Duodenal / Jujenal Feedings

Infused over:
16-24 hours

less aspiration risk vs bolus

18
Q

CYCLIC INFUSIONS
​Techniques of Administration

A

Supplemental
supplement patient’s oral diets

Also, Gastric / duodenal / jujenal feedings

Infused:
OVERNIGHT = 8-12 hours

Allows patients to be:
MORE MOBILE & does NOT suppress appitite during the day

19
Q

Continuous Infusion / Cyclic
​Techniques of Administration

A

Start LOW & titrate fairly QUICKLY (q4-8 hours)

CRITICALLY ILL
10-20 mL/hr
increase by 10-20 mL/hr to goal rate

NON-Critically Ill
20-50 mL/hr
increase by 20-25 mL/hr to goal rate

Final goal rate depends on:
caloric density & protein content of the formula

20
Q

Complications & Monitoring
of EN

A
  • *GASTROINTESTINAL**
  • *Intolerance / Diarrhea / Dumping Syndrome**

Aspiration / HYPERglycemia / Fluid Imbalance

Signs that they are NOT TOLERATING the feeding

  • *Abdominal Pain** / INCREASED Abdominal GIRTH
  • *Vomiting**
  • *Tube Feedings in the NG suction**
  • monitoring gastric residual no longer recommended*
21
Q
  • *Management of Complications**
  • *Gastrointestinal = INTOLERANCE**
A

HOLD continuous tube feedings for 4-6 hours

RESTART tube feeding @ 50% of previous rate
and titrate back to goal as tolerated

  • If above does not work / fails:*
  • *Metoclopramide = 10mg po/iv q6hr**

Erythromycin = 250mg po/iv q6hr

  • *Advance TUBE –> SMALL BOWEL**
  • *ND or NJ tube**
22
Q

Management of EN Complications
Gastrointestinal = DIARRHEA

A

Rule out MEDS or C.DIFF

DECREASE RATE BY 50%

Change to –> ISOTONIC or FIBER-Containing

Add –> MODULAR FIBER SUPPLEMENT
benefiber / fibersure

LAST RESORT:
Add Anti-Diarrheal Medication
Loperimide // Diphenoxylate + Atropine

23
Q
  • *Management of EN Complications**
  • *Gastrointestinal - DUMPING SYNDROME**
A

Symptoms:
Weakness / Diaphoresis / Palpitations

Mechanism:
High Osm load in the small intesting

Management - Switch to:

  • lower* Osm feeding / decrease tube feeding # or rate
  • *CONTINUOUS feeding** vs bolus
  • *GASTRIC feeding**
24
Q

Management of EN Complications
ASPIRATION

A

Management:
PREVENTION

check tube placement

ELEVATE Head of Bed
30-45 degrees

Post-Pyloric Feedings

25
Q

Management of EN Complications
HYPERglycemia

A

OVERFEEDING is most likely cause

Reassess Caloric Needs

  • Reduce:*
  • *Tube feeding rate** / Carbs

INCREASE:
FAT & more soluble FIBER

  • Last resort:*
  • *Insulin**, may promote steatosis in overfed patient
26
Q

Management of EN Complications
Certain Medications

A

tube feedings should be:

HELD FOR 1 HOUR

BEFORE & AFTER
admin of certain medications

27
Q

Management of EN Complications
Clogged Feeding Tube
Common

A

TO PREVENT:
FLUSH 30mL of Lukewarm water Q4hrs

Treat:
>50 mL of lukewarm water
or:
CLOG ZAPPER
combo of enzymes / acids / buffers

PDAT3 (23 decks)

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